Oregon

Daniel Robbins has been on death row for nineteen years (half of his life) when the execution warrant arrives.

29 October 2004. One minute after midnight.

29 October is my birthday, so the date instantly hooked me in. When we’re young we count down the days – or sleeps! – to such dates; imagine counting down to your own death, or that of someone you love.

Robbins had a troubled upbringing, in and out of care, and there’s now no one in the outside world who’s in contact with him. But he remembers one thing his real mother taught him: Truth is not necessarily what people want to hear, and now he’s in prison because he failed to tell the truth – the truth about how, in 1985, he came to shoot dead 15-year-old Shep Stanley. Shep’s father is Deputy Sheriff Nathaniel Stanley (Nate), and it was he who found the fatally wounded boy. He cradled Shep while he bled to death, and his testimony helped put the 19-year-old shooter in the state penitentiary, and on death row.

Shep’s mother, Irene, is beside herself, depressed and suffocated by pain. Shep was the apple of her eye, her world. Even her daughter, Bliss, feels left out. Believing she couldn’t cope with hearing the truth about what really happened on the night of her son’s murder, Nate keeps the secret for nineteen years. Until, that is, he discovers his wife has been secretly writing to the condemned man for years … that she’s forgiven him. Incensed beyond control he blurts out the truth. The revelation catapults Irene into a frenzy of activity which takes her all the way to the window opposite her son’s killer.

The book, The Crying Tree ( a perfect title) is cleverly structured. The first section flips between the years leading up to the murder and its aftermath (1983-1990) – and the days immediately after the death warrant comes through (the first two days of October 2004). The second part picks up at 1995 and takes us up to 7 October 2004. The third and fourth sections inch us ominously through the remaining days of October 2004 as the condemned man counts down the rest of his mortal life.

I didn’t see the twist at the end of section 3 coming – always a thrill! – and Irene’s reaction to the truth Nate reveals is powerfully captured in some brilliant passages describing her whole life disintegrating (P247-8), beginning with ‘Irene drove south on Highway 3, speeding past river towns like Neunert and Grand Tower. Headlights made her squint, trains made her stop, and the words her husband had said made her shake with fury … she had no idea what to do with Nate’s confession.’

Alongside the story of the Stanleys’ life and tragedies, we walk beside the man responsible for masterminding the actual execution, Superintendent Tab Mason. He’s a damaged soul himself after years of terrible abuse. He feels the weight of his responsibility acutely – it’s not a job, it’s an ‘ordeal’ – and he has real issues with the notion of forgiveness. Execution is a rare occurrence in Oregon; the last one was seven years earlier, and this is Mason’s first case being ‘in the driving seat’. ‘We’re talking about a man’s life, and I won’t be tolerating any talk that may lead someone to believe we are in any way eager to take on this job.’ He’s determined that every man jack involved in any way, is prepared for this. ‘There are thresholds on the road to killing someone … everyone, from officer to cleanup crew, had to figure out whether or not he had it in him to cross over that line.’

But his careful planning and preparation is thrown into chaos when the murdered man’s mother writes to him … when she arrives seeking mercy … when her daughter supports her – a woman who is herself a criminal prosecutor who’s ‘probably put more men to death than he had sitting in his entire unit‘! It’s a ‘compellingly outrageous‘ situation to be in.

The author of this superb book, Naseem Rakha, an acclaimed journalist, doesn’t shirk the big questions either. The rightness of capital punishment. The Biblical understanding of Do Not Kill. Religion and homosexuality. The meaning and consequences of forgiveness. How grief affects people. Punishment and imprisonment. Nature versus nurture. Weighty questions all.

And her command of language is fabulous. I Iove the idea of
– a face ‘buttered with sympathy’ or ‘buffed of expression and the eyes drained of color’, of – a man running to ‘get as far away from himself as possible’. – the women in a backwater, ‘their long flannel shirts covering up what gravity had claimed’.– the people in the tavern ‘strung out on a line waiting for life to turn better’.

Her masterly handling of suspense and conflict, particularly in the chambers where the deed will be/is done, chills the spine. I experienced a CT procedure recently which necessitated everyone else leaving the room leaving me alone in the tunnel with an IV infusion to automatically shoot dye into my veins and thence into my heart, while a robotic disembodied voice warned me it was coming, and my body reacted strangely to the substance. It felt weirdly isolating. And I could see parallels. Only, in my case, I lived to recall the experience!

The Crying Tree is no run-of-the-mill miscarriage of justice story, no who-really-done-it. This is a tale that gets deep inside the heart of a family torn apart by the murder of a beloved and talented son, an act that forever changes the meaning and cohesion of their lives and relationships. Some of the attitudes and language make us cringe today in the UK, but this was the US in the 2000s, and it’s a salutary reminder of how prejudice, ignorance and intolerance can ruin lives. Shep’s mother ends up realising she failed her son, but ‘We all make mistakes … Every one of us. And we all pay. One way or another, we all pay.’

To begin with, another state in the USA, California, has made assisted suicide legal as from 1 January next year. They are the fifth state to do so. The law, based on a similar measure in Oregon, allows doctors to prescribe drugs to end a patient’s life if two medical practitioners agree the person has only six months to live and is mentally competent. Interestingly, in this case, the law as it’s presently written, will expire after ten years unless extended. Apparently this was a compromise made for those lawmakers who fear unintended consequences such as targeting of the poor, disabled or elderly. Sounds like a sensible caution to me.

This week too, we’ve heard of a report by the Economist Intelligence Unit, which finds the UK ‘the best place in the world to die’ as the newspapers put it; top of 80 countries involved in their survey when it comes to end-of-life care. Key factors are identified as a strong hospice movement, palliative care integrated into the NHS, specialised staff, and hospital/community integration … hmm … more of this anon.

Then, building on this, Baroness Ilora Finlay, a major spokesperson on the topic, and herself a former medical consultant in palliative care, came on TV this week to talk about her draft Palliative Care Bill which tries to address the disconnect between medical and social services in care of the dying; to provide equitable and efficient care for all. Being top in the survey is encouraging, she says, but there’s still plenty of work to be done to ensure excellence across the board. Indeedy!

The emphasis is on really listening to what the families need at a time when they are caring for a loved one, and providing a central hub for familes to liaise with, in order to avoid the frustration of time and effort wasted searching for the right people to help.

This all resonates for me at the moment. Someone I care about was recently admitted into the acute NHS system, into a vast, bright new shiny hospital, for management of her broken hip. Sybil (not her real name) is in her nineties, she has dementia, she is bewildered and confused by the alien environment, as well as immobilised by a fracture and on medication for pain relief. I’m quite sure her actual medical treatment was expert: the hip was fixed rapidly. But – a big BUT – the staff in the two wards Sybil was placed in were openly hierarchical, those with power seemed to have no time to listen, no willingness to know what would help to keep this lost wee soul calm and secure. It was down to us who know and love her to try to fill these gaps as best we could in the times we were able/permitted to be with her. And it was obvious that Sybil was not happy; she caused mayhem on more than one occasion!

This week she’s been transferred to a low-tech community facility; older, more run down, higgeldly-piggedly. But the difference inside the ward housing her is palpable too. Everywhere you go staff are friendly and helpful, anxious to accommodate the needs of the patients in their orbit; anything that will help Sybil settle and smile is welcomed. We can walk away knowing she’s in good hands. She’s already visibly more relaxed.

Good care is so much more than up-to-the-minute medicine. And when it comes to elderly people with dementia, it’s often the little things that make the difference between wanting to go on and preferring to die; little things that tell them they are valued and cherished and understood.

Fifty years ago I wrote an essay – using this very Parker pen – about the care of patients being so much more than delivering technical procedures efficiently. It won a prize from the British Medical Association no less! Back then the medical technology and capability we take for granted in the twenty-first century was undreamed of, but basic human needs remain much the same. That message is needed every bit as much. Let’s not lose sight of this in all our cleverness.

This past weekend, on 1 November 2014, a beautiful and highly intelligent young American woman of 29 calmly and deliberately took her own life in Oregon, with the tacit agreement of those who loved her devotedly. She and her new husband moved there from California so that she could legally take this step.

Though I never knew her, I feel sad that Brittany Maynard has missed out on so much that is wonderful in life. Nevertheless I understand her actions: she was terminally ill with a brain tumour and she did not want to deteriorate slowly and unpleasantly. Who can blame her? As she said herself: ‘I do not want to die. But I am dying. And I want to die on my own terms.’

As it happens, I’ve been identifying more closely with this vexed issue of assisted death than usual this week, because while Brittany was calmly contemplating taking a fatal dose of prescription medicine, doctors were actually working hard to save my life.

After seven decades of valiant but largely taken-for-granted service, my old heart decided to make its presence felt and create a bit of havoc in my life. It has set a few records in speed and variety of rhythm over the past week, and when this vital organ is pounding along at 200 beats per minute and assorted members of the medical fraternity are glued to the monitors; when my GP tells my spouse that if ‘anything happens’ between the surgery and hospital, he should pull over and dial 999 – ‘no heroics’; the prospect of death seems unusually close! What’s more, as I am now officially at greatly increased risk of sudden death, heart attack, stroke or other cerebro-vascular disasters, my mind is focusing rather more acutely on what I would choose to happen to me, if I were able to influence anything. And what control I wish to presume over the outcomes. Hmmm.

This is a personal matter for me to ponder, and to some extent share with my loved ones. But the thing I’m carrying away with me from this little skirmish with serious illness is the kindness of strangers. These doctors and nurses who have never seen me before, who will probably never meet me again, who treat hundreds of thousands of assorted odd-bods, have treated me with such friendly efficiency, and respect and dignity and warmth. They’ve even returned expressly to voice their pleasure at my recovery. I’ve been both touched and humbled.

The NHS might indeed often get a bad press – even from its own practitioners! – but when it’s a matter of life and death they can certainly pull out all the stops. I am hugely in their debt. They went well beyond the call of duty for me.

Then two years ago MSP Margo Macdonald waged her passionate campaign to get assisted dying accepted in Scotland. I watched her in action, I listened to her in the flesh, and I honestly thought her End of Life Assistance (Scotland) Bill would get somewhere, given the publicity she generated and her own personal struggle with Parkinson’s Disease. But no. I was wrong again. It was thrown out.

Now this month Lord Falconer has published his report on behalf of the Independent Commission on Assisted Dying (set up and partly funded by Sir Terry Pratchett). The story is similar. They recognised the distressing situations people find themselves in under the present system, the anxiety it causes healthcare providers, and the challenging burden it represents for the police and prosecutors, and found the present law both ‘inadequate‘ and ‘incoherent‘. They looked for a solution for people with the mental capacity to request assistance and a clear sustained wish to die.

Once again practices in other countries that permit varying levels of assisted death came under scrutiny. The Commission ‘did not like much of what they saw.‘ In Switzerland, the Dignitas clinic is an alien environment where patients are far away from loved ones. In Oregon, patients must take 90 pills, often without a doctor present. In the Netherlands, even teenagers and people with mental illness are helped to die. The Commission deemed all these practices undesirable for Britons.

But in any case, irrespective of the efficacy of practices elsewhere, in reality the opportunity to go abroad for death is really only available to the wealthy. Furthermore, because of the threat of legal action against relatives who assist them, many are forced to take their own lives early while they are still physically able to do so. So, nothing new; but the painful truths revisited and reiterated.

Like their predecessors, the Commission came to the conclusion that a change is overdue. GPs should be able to prescribe lethal doses of medication for dying people to take themselves, they said.

Lord Falconer’s recommendations though, are much narrower that Margo Macdonald’s. They would only apply to people with less than a year to live, who are capable of drinking the medication unaided. They do not include those who are suffering unbearably but for whom death is not imminent. Neither Margo herself, nor the redoubtable right-to-die campaigner Debbie Purdy who has MS, would qualify. After all they’ve done to open up the debate and clarify the law! A retrograde step surely, not to cater for the people in greatest need of help. Because in reality, terminally ill patients close to death are often helped subtly and carefully and lovingly to have a good death. It’s the ones with lingering declines because of conditions that rob them of power and control and dignity inch by degrading inch that we need to worry about most.

In fairness, this latest august committee conceded that there are dangers in what they recommend and extreme caution is needed. Pressure might be exerted on vulnerable people to end their lives – either from within themselves or from family members. Hence, in their scheme of things, disabled people, or those with depression or dementia, would be ineligible for assistance.

Or maybe they felt that a staged approach is advisable. Start small. Test the water. It’s conceivable. But could backfire.

The next step would be to discuss their report in parliament. But it will inevitably face stiff opposition. Politicians have proved themselves reluctant to back this particular hot potato. Vocal religious leaders are against the taking of life – full stop, and few politicians will risk alienating them. And many in the medical profession are reluctant to publicly support something which appears to fly in the face of their avowed duty and intent to save life and do no harm, although, if you read the evidence to the Commission you’ll see that a considerable number of eminent doctors do privately support a change in the law.

Nevertheless the report places much of the burden for implementing change on doctors. They are the ones who must screen eligible patients, tell them about possible alternative treatments, deliver the lethal prescription, be present during the final moments, cooperate with the police, and report to a monitoring service. Burdensome indeed. Especially if you have personal reservations. And many doctors fear that allying themselves with such a death service would compromise their relationship with their other patients.

But identifying any category of person to take this role presents me with my personal biggest dilemma. It’s easy enough for those who aren’t medically trained to insist, ‘Oh yes, somebody should help these people to die.’ But would they be prepared to administer that fatal dose? To live with the knowledge that their action had killed a fellow human being? Me, I feel sick if I accidentally step on a snail! I couldn’t even finish off an almost-dead rabbit left behind by a hit-and-run driver. Squeamishness personified, me. Who am I to say, ‘Yes, we need this change, but you do it, not me’ ? That’s where all my carefully worked through logical reasoning breaks down.

This time I haven’t spoken to Lord Falconer in person, but if I had to declare my opinion as to the future of this latest attempt to offer assistance with dying in the circumstances outlined, I would rate it unlikely to succeed. Especially given the accusations flying around of bias and prejudice in this particular committee. And the problem of knowing who has less than a year to live. And the expertise required to assess people with a terminal illness for anxiety and depression – could GPs do it? And the time necessary to establish a sustained and genuine wish for death.

However, talking about these controversial and emotive issues that involve unbearable suffering and mental anguish, has to be better than sweeping them under the carpet. So if it keeps the issues alive it will have served a function. And in the meantime, let’s just hope and pray that those who need it get excellent palliative care from staff who support the concept of a pain-free dignified death.

Curious really, Right to Die came out in 2008 but is just as topical in 2012. The reverse of what I expected when I wrote it.